Healthcare Provider Details

I. General information

NPI: 1124719828
Provider Name (Legal Business Name): SCOTT ERIC NORDSCHOW BSN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MONTGOMERY ST
DECORAH IA
52101-2325
US

IV. Provider business mailing address

3345 US HIGHWAY 52
DECORAH IA
52101-7715
US

V. Phone/Fax

Practice location:
  • Phone: 563-382-2911
  • Fax:
Mailing address:
  • Phone: 563-380-9634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number167038
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: